In 1990, then-26-year-old Brad Reinke was waiting at his parents'
Northwest Austin home when they returned from church. As he attacked his
father with a knife, his mother fought him off with a baseball bat,
court records say.

Found to be too mentally ill to stand trial,
Reinke was sent to Vernon State Hospital, one of Texas' taxpayer-funded
psychiatric hospitals, to undergo "competency restoration," in which
anti-psychotic medication and therapy are used to stabilize a criminal
defendant enough to stand trial.

On average, the process takes about three months. More than 20 years later, however, Reinke is still a hospital patient.

So
is James McMeans, accused of a 1999 fatal stabbing at a South Austin
gas station. Psychiatric workers at Kerrville State Hospital have
restored him to mental competency three times, most recently last year,
only to have him regress each time he returned to jail to await trial.
He has remained a hospital resident for more than a dozen years.

Within
Texas' network of mental health facilities, the 10 taxpayer-supported
state psychiatric hospitals (one is for juveniles only) are intended to
be used primarily as a short-term stop for patients and defendants in
need of intensive temporary treatment before moving on to less
restrictive facilities or back into the community.

But an analysis
of patient data shows that increasingly, that's not the case. In recent
years, the 2,400 beds in the facilities have been stacking up with
patients staying much longer — some for decades.

Regular readers will recall that Travis County District Judge Orlinda Naranjo recently ordered state mental hospitals to accept even competency restoration patients (in state hospital parlance, "forensic commitments") within three weeks of a judge's order, the result of years of litigation (that fwiw was initially launched in response to a Grits commenter) over long waiting lists that left mentally ill defendants lingering in county jails for months and months pretrial. Dexheimer's story provides context for that litigation, showing how forensic commitments are increasingly coming to dominate state mental hospitals, squeezing out non-criminal cases.

In 2001, forensic patients made up 15 percent of those in the
hospitals. Today, they are 40 percent, and the numbers are growing. The
shift is significant because psychiatric criminal defendants tend to
stay much longer. Department of State Health Services statistics show
the average time patients stay in a state hospital climbed about 30
percent in the past five years. ...

Because
they remain clinically unwell or dangerous, insanity defense patients
are stacking up, too. Four years ago, the state psychiatric hospitals
housed 90. Today, there are more than 200 — growing at a rate of 22
percent each year.

Equally concerning, the expansion of forensic commitments has led to excessive incarceration of mentally ill defendants pretrial, sometimes for longer, even than the law allows, just because folks get lost in a byzantine system whose actors have few options available to them and few incentives for leniency:

Advocates say some long-term patients might not belong at all. Last
September, Disability Rights Texas, a watchdog organization federally
authorized to investigate state mental health facilities, won release of
a man who'd been arrested for unauthorized use of a motor vehicle and
sent to a state hospital to have his competency restored. The law says
such patients can stay no longer than the maximum criminal penalty
they're facing — two years, in this case. By last year, the man had been
a state hospital resident for closer to eight, said Beth Mitchell, the
organization's attorney.

Since March, reviewers for Austin Travis
County Integral Care, which coordinates the area's mental health
services, have identified 13 patients — including one who'd been in the
hospital for 5½ years — being kept at the psychiatric facilities without
sufficient clinical reason.

Together, the long-termers have
effectively reduced the hospitals' capacity more and more every year. In
2004, 1 in every 7 beds was taken by a patient who'd been there more
than a year. Today, it's 1 in 4.

Texas has under-invested in infrastructure for indigent mental health treatment to the point where, increasingly, mentally ill folk must commit a crime to receive inpatient treatment. Dexheimer points to outpatient programs funded by the Legislature as pilots aimed at restoring competency for misdemeanants, but their slight scope barely amounts only to an acknowledgement of the problem, not a near-term solution.

In Grits' view, there are several interrelated pieces that need to happen on competency restoration at different levels of government to get at the root of the problem. First, Texas must invest more in state mental-hospital beds and expand community-based treatment services outside of (read: prior to) the criminal justice system. Larger cities need supportive housing for chronic mentally ill "frequent flyers" who take up a disproportionate amount of jail and court resources. And finally, local jails need to be more proactive in their approach instead of waiting for courts and state hospitals to address defendants' competency.

Harris County has arguably the best front-end approach to dealing with competency restoration among large Texas jurisdictions, IMO. As Grits wrote in February, Harris doesn't wait to treat incompetent inmates until they're
sent to the state hospital. They screen, identify and assess mentally
ill defendants quite rapidly on the front end as they're entering the
jail. In particular, wherever possible, the jail identifies mentally ill
inmates' medications through past jail records, prescription-drug
databases, from their personal physicians, local clinics, etc.,
particularly for frequent flyers. Usually the first steps toward
competency restoration begin well before anyone issues a court order to
that effect. The result: Harris has a lot fewer backlogged inmates
awaiting competency restoration for long stretches, and those Harris
sends to state hospitals tend to have shorter lengths of stay compared
to other jurisdictions. (Harris, the state's largest county, had 9
inmates who'd waited longer than 60 days for a bed, according to the Dallas News, compared to 66 in Dallas who'd waited longer than 70 days.)

Defendants deemed incompetent can't just plead guilty and serve out their sentence. They've been declared incapable of making their own decisions and their fates lie in the hands of the state. Dexheimer's report shows how the state tends to make those decisions based on its own self interest, not that of the individuals whose rights the process has stripped away.

6 comments:

Anonymous
said...

judges are the only ones who allow crap like this to happen. not surprised that a judge didn't close a case in 20 years - some lawyer buddies must have been making tons of money on this one. pointing fingers elsewhere is dumb - its the judges.

I'm a long way from Texas, but I need to say that psych patients are the same all over--very, very few charges are for violent offenses. People with mental illness are much more often victims of violence than perpetrators. Charges are usually for nuisance offenses, socially inappropriate or unlawful activities that persist and annoy others--things that can't be dealt with and have to involve the police. People with mental illness are not really more dangerous than the rest of us.

Obviously, community treatment is far, far cheaper than jail, state hospital, or prison. Even close management in the community.

Do you only mean folks judged mentally incompetent? So the rest of us defendants, for lack of an attorney who cares or is competent, are NOT incompetent? And if we're broke, so the court appoints a defense attorney, does that make us incompetent? I'd think more and more folks are not going to be able to defined themselves against the growing numbers of bogus "crimes" defined by legislature and evolved policies of revenue-raisers.

Actually, in the Reinke case it's the prosecution that is keeping him in the competency restoration cycle - they are claiming they can keep him there indefinitely. His lawyer argues that after 20 years - the maximum sentence he could face - he needs to be out of the criminal and into the civil commitment zone. The case is pending in the CCA at present.

You make very good points and in total agreement. Judges get a bad rap for prosecutors dragging their ass. This goes back to Prosecutor accountability. Until they are required to "show for the money" their will be little to no quality assurances in place.

My 18 year old daughter who has never been in trouble was arrested for trespassing. While in jail an officer their through her to the ground ch8in first and she blocked his hits. Her filed felony assault charges on her. She did not understand she had been charged with a felony, because she did not do anything. The public defender ordered a compentency evaluation on her which deemed her incompetent to stand trial. The felony assault charge was dropped but the misdemeanor judge is sending her to a state hospital. She has now been in jail over thirty days and is very much competent.

Southern, daily and good for you

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